Persistently increased injury mortality rates in high-risk young children
S. J. Scholer, G. B. Hickson, E. F. Mitchel Jr and W. A. Ray
Department of Pediatrics, Vanderbilt University, Nashville, Tenn., USA.
OBJECTIVE: To study trends in injury mortality for low- and high-risk young
children. DESIGN AND METHODS: For Tennessee children 0 to 4 years of age,
we used birth certificates to obtain data on maternal education, age, and
parity; these risk factors were used to classify children into low- and
high-risk groups. The outcome was death from injury, as determined from
linked death certificates. Between 1978 and 1995, injury mortality rates
were calculated for six 3-year periods for low- and high-risk children.
RESULTS: There were 1.5 million children 0 to 4 years of age who
contributed 4.9 million child-years. The high-risk group contributed 28% of
all child-years. There were 673 injury deaths in the high-risk group, 48.9
deaths per 100,000 child-years, and 586 deaths in the low-risk group, 16.8
deaths per 100,000 child-years. The injury mortality rate for low-risk
children decreased from 20.7 to 15.7 per 100,000 child-years between the
1978-1980 and 1981-1983 periods; thereafter it remained relatively stable.
For high-risk children, the injury mortality rate decreased from 50.9 to
43.5 per 100,000 between the 1978-1980 and 1981-1983 periods, remained
mostly unchanged through 1992, and then increased sharply in the 1993-1995
period to 64.1 per 100,000 child-years. The disparity between high- and
low-risk children widened from 29.3 (95% confidence interval, 25.1-33.5)
excess deaths per 100,000 for 1978 through 1991 to 46.9 (95% confidence
interval, 35.9-57.9) in 1993 through 1995. CONCLUSIONS: In Tennessee,
maternal education, age, and parity consistently identified a population of
children at increased risk of injury mortality. For these high-risk
children, there has been no substantial reduction in injury mortality in
high-risk young children during the last 18 years.
